Suicide

Euthanasia is a word coined from Greek in the 17th century to refer to an easy, painless, happy death. In modern times, however, it has come to mean a physician's causing a patient's death by injection of a lethal dose of medication. In physician-assisted suicide, the physician prescribes the lethal dose, knowing the patient intends to end their life.

According to a survey done in 1999, 54% of Oregon's psychiatrists and 75% of the state's psychologists supported physician-assisted suicide, whereas between 20% and 33% of all health care professionals opposed it. The debate continues, as the federal government is trying to take away prescribing privileges for physicians who prescribe life-ending medications.

Can PET scans show differences in suicide risk among depressed patients? What are the risk factors for high-lethality suicide attempts versus low-lethality attempts?

This summary of the special report looks at various new ways to assess and treat for suicidal ideation, risk and behavior.

Two of the most prevalent risk factors for suicide are family history of suicide and family history of psychiatric illness. Are these factors independent of each other? What role does genetics play? How can research in this area assist prevention programs?

Although studies have already shown that alcoholism can greatly increase the risk of suicide, a new published study has discovered that age is also a factor in suicide among alcoholics.

While the deaths of several students have figured prominently in recent news, studies show that college students actually have a lower rate of suicide than their nonstudent peers. What can be done to lower suicide rates even further?

College students are far less likely to kill themselves than are nonstudent peers, according to a 10-year research study examining suicide rates at 12 Midwestern campuses.

Beyond the threat of malpractice suits, losing a patient to suicide can be one of the most profoundly disturbing experiences of psychiatrists' professional careers. Yet, there is sparse literature on the occurrence and scant attention given to it in residency training programs (Gitlin, 1999).

On May 3, U.S. Surgeon General David Satcher, M.D., launched a national plan to reduce the suicide rate in the United States. A collaborative effort by the Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and Prevention, the National Institutes of Health, and the Health Resources and Services Administration, the National Strategy for Suicide Prevention maps out 11 goals and provides a blueprint for action on those goals.

This is the second part of an article series discussing the high risk of suicide attempts in patients with schizophrenia. Herbert Y. Meltzer, M.D., continues the discussion with treatment options and efficacy.

Patients with schizophrenia have a high risk of committing suicide. Between 25% and 50% attempt suicide at least once, resulting in approximately 3,600 successful attempts each year in the United States. What are the risk factors for suicide one should look for in treating patients with schizophrenia? Herbert Y. Meltzer, M.D., discusses the issue and offers warning signs.

In Western psychiatry, depression is considered a major cause of suicide. But research from China calls that assumption into question. More than 300,000 suicides occur annually in China, nearly 10 times the number of suicides in the United States.

Is it appropriate for physicians to accept assisted-death requests at face value, or should they be interpreted as clinical indications of suffering? Should physicians act on patient requests to die, or should they address patient needs through other measures? Such are the difficult questions facing most physicians today.

There is and has been much debate about the issue of assisted suicide as physicians, lawyers and lay people argue the pros and cons of assisting in someone's death. The physician who agrees to participate in this endeavor points out that his or her concern is to alleviate suffering. Notwithstanding that, painkillers are notoriously prescribed in inadequate, understrength doses; people with serious illness who are depressed are considered unlikely candidates for treatment of their depression because, sayeth the physician: "It is only natural, understandable, to be depressed with that kind of terrible illness."

Approval of the nation's first physician-assisted suicide law last November has proved the adage "be careful what you wish for." In the aftermath of the Oregon initiative that once again endorsed the state's Death with Dignity Act, physicians and government officials throughout the country are now scrambling to make sense of the law and figure out ways to assure that compliance doesn't lead to liability, both criminal and civil.

In a long-awaited decision that culminated often anguished public debate and agonizing over moral and ethical concerns, the U.S. Supreme Court in June reversed the opinions handed down by the 2nd and 9th Circuit Courts of Appeal and held unequivocally that there is no constitutional "right to die." The controversy over physician-assisted suicide will now spread, as each of the 50 states becomes a separate battleground. "Throughout the nation, Americans are engaged in an earnest and profound debate about the morality, legality and practicality of physician-assisted suicide," said Chief Justice William H. Rehnquist. "Our holding permits this debate to continue, as it should in a democratic society."

Brain serotonin levels as a predictor of suicide has been the subject of intense research scrutiny over the past several years, with scientists trying to find easily accessible markers so that the neurotransmitter's levels might someday be readily measured in clinical settings.

Late last year, Oregon voters approved a law that would permit doctors to prescribe lethal drugs to patients judged to be in the last six months of life. Oregonians are setting out on a path that the Dutch have traveled for the past 20 years.